Healthcare Provider Details

I. General information

NPI: 1770437915
Provider Name (Legal Business Name): KATELYN MICHELLE EASTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 PROFESSIONAL CT
LAFAYETTE IN
47905-5152
US

IV. Provider business mailing address

610 4TH ST
COVINGTON IN
47932-1129
US

V. Phone/Fax

Practice location:
  • Phone: 765-756-5077
  • Fax: 800-810-3955
Mailing address:
  • Phone: 317-966-8642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number71017788A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: